Abstract
Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.
Highlights
Childhood malnutrition remains a major public health problem throughout the developing world, being the underlying factor for nearly half of all yearly under-5 deaths from preventable causes [1].It is estimated that more than 50 million children worldwide are affected by acute malnutrition, with 16 million having Severe Acute Malnutrition (SAM) and a further 33 million having ModerateInt
In community-based management of acute malnutrition (CMAM) programs, children with moderate acute malnutrition (MAM) are the main target of SFPs, while severe acute malnutrition (SAM) rehabilitation is addressed by OTPs and/or Inpatient Care (IC) [21,22]
Within the Zambian context, since the access to OTP/IC is restricted and/or the supply of ready-to-use therapeutic food (RUTF) is erratic in most areas in which Rainbow operates, children with SAM are enrolled in Rainbow SFPs, in addition to referral to OTP/IC as the best practice
Summary
Childhood malnutrition remains a major public health problem throughout the developing world, being the underlying factor for nearly half of all yearly under-5 deaths from preventable causes [1].It is estimated that more than 50 million children worldwide are affected by acute malnutrition, with 16 million having Severe Acute Malnutrition (SAM) and a further 33 million having ModerateInt. Childhood malnutrition remains a major public health problem throughout the developing world, being the underlying factor for nearly half of all yearly under-5 deaths from preventable causes [1]. It is estimated that more than 50 million children worldwide are affected by acute malnutrition, with 16 million having Severe Acute Malnutrition (SAM) and a further 33 million having Moderate. Res. Public Health 2018, 15, 1807; doi:10.3390/ijerph15091807 www.mdpi.com/journal/ijerph. In all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in
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